Method of implanting a bone fixation assembly

ABSTRACT

A bone fixation assembly can include a suture button, a bone plate, and a suture assembly. The suture button can include a body that has a first end surface, a second end surface, and a circumferential outer surface. A first pair of passages can be formed through the body from the first end surface to the second end surface. The circumferential outer surface can include at least one protrusion or retaining rib extending radially therefrom. The bone plate defines an aperture. The suture button is configured to be at least partially received into the aperture in an assembled position such that the retaining rib engages the bone plate and inhibits withdrawal of the suture button from the aperture in the assembled position. The suture assembly includes a suture engaging member and a suture configured to couple the suture engaging member in the suture button.

FIELD

The present disclosure relates generally to bone fixation and moreparticularly, to a clavicle fixation assembly including a suture button,a bone plate, and a suture assembly that are used in combination toposition a clavicle at a desired location relative to a scapula.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

Portions of the anatomy can generally be formed relative to one anotherto allow for a natural articulation, support, movement, or the like.Nevertheless, due to various circumstances, such as injury, disease, orthe like, various portions of the anatomy can become damaged. Forexample, a bone portion and/or surrounding tissue may become damaged ina manner that is substantially unnatural. It may be selected to performa procedure relative to the bone portion to recreate the more naturalbone portion.

For example, in some instances, a clavicle can become partially orcompletely fractured causing the clavicle, in some instances, to becomemisaligned relative to the surrounding anatomy including a coracoidprocess of a scapula. In some instances, coracoclavicular ligaments thatconnect between the clavicle and coracoid process can tear, causing aclavicle to unfavorably displace superiorly. In some circumstances, itmay be difficult to properly locate the clavicle relative to a scapula.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

A bone fixation assembly can include a suture button, a bone plate, anda suture assembly. The suture button can include a body that has a firstend surface, a second end surface, and a circumferential outer surface.A first pair of passages can be formed through the body from the firstend surface to the second end surface. The circumferential outer surfacecan include at least one protrusion or retaining rib extending radiallytherefrom. The bone plate defines an aperture. The suture button isconfigured to be at least partially received into the aperture in anassembled position such that the retaining rib engages the bone plateand inhibits withdrawal of the suture button from the aperture in theassembled position. The suture assembly includes a suture engagingmember and a suture configured to couple the suture engaging member inthe suture button.

According to additional features, the suture button can further define asecond pair of passages formed through the body from the first endsurface to the second end surface. The body can also define a pair ofradial openings that connect the second pair of passages, respectivelywith the circumferential outer surface. The suture button can furtherdefine a central passage. The first and second pair of passages can belocated radially outwardly on the body relative to the central passage.

According to other features, the button can have a body that has anupper portion having a first diameter and a lower portion having asecond diameter. The first diameter can be larger than the seconddiameter. The retaining rib can be formed on the lower portion. In oneexample, the first pair of passages taper toward each other from thefirst end surface to the second end surface. The lower portion can beconfigured to be received at least partially into the aperture of thebone plate and the upper portion can be configured to extend proud fromthe bone plate in the assembled position.

According to some examples, each passage of the first pair of passagesis further defined by a chamfer surface that connects the first endsurface with a radial sidewall. The aperture in the bone plate can bethreaded such that the retaining rib positively engages the threads inthe assembled position. The suture engaging member can comprise anelongated member having a passage formed therethrough. The suture can beconfigured to be looped through the passage in the suture engagingmember. The elongated member can be configured to engage a bone in theassembled position such that the elongated member is inhibited frommoving toward the suture button. In other examples, the elongated membercan comprise a flexible tube that defines the passage. The flexible tubecan be configured to expand and engage the bone in the assembledposition.

A method of implanting a bone fixation assembly includes preparing afirst hole through a clavicle. A second hole can be prepared through acoracoid process. A bone plate having an aperture can be positionedagainst the clavicle. A portion of suture can be located through theaperture, the first hole, and the second hole until a retaining memberslidably disposed on the portion of suture locates against an outersurface of the coracoid process. A second portion of the suture can bepassed through an aperture defined in the suture button. The suturebutton can be positively located into the bone plate aperture. Thesecond portion of suture can be drawn away from the outer surface of thecoracoid process causing tension between the retaining member and thebone plate. The second portion of the suture can be secured at aposition that maintains the tension.

In some examples, positively locating the suture button includesengaging retaining ribs formed on a circumferential surface of thesuture button with threads formed in the bone plate at the aperture.Drawing the second portion of the suture away from the outer surface ofthe coracoid process can include manipulating the retaining member froma first position that has an outer profile generally suitable to passthrough the first and second holes to a second position that has anouter profile generally unsuitable to pass through the first and secondholes.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 is a posterior perspective view of a bone fixation assemblyconstructed in accordance to one example of the present teachings andshown in an implanted position relative to a right clavicle and scapulaof a patient;

FIG. 2 is an exploded perspective view of the bone fixation assembly ofFIG. 1 and shown relative to a clavicle, coracoid process, and acromion;

FIG. 3 is a superior plan view of the bone fixation assembly of FIG. 1;

FIG. 4 is a cross-sectional view of the bone fixation assembly takenalong line 4-4 of FIG. 3;

FIG. 5 is a plan view of an exemplary bone plate of the bone fixationassembly;

FIG. 6 is a perspective view of a bone plate constructed in accordancewith additional features of the present teachings;

FIG. 7 is a front perspective view of a suture button constructed inaccordance to one example of the present teachings;

FIG. 8 is a plan view of the suture button of FIG. 7;

FIG. 9 is a cross-sectional view of the suture button taken along line9-9 of FIG. 8;

FIG. 10 is a perspective view of another suture button constructed inaccordance to other features of the present teachings;

FIG. 11 is a plan view of the suture button of FIG. 10;

FIG. 12 is a cross-sectional view of the suture button taken along lines12-12 of FIG. 11;

FIG. 13 is a cross-sectional view of the suture button shown in FIG. 7in an assembled position relative to the bone plate of FIG. 5;

FIG. 14 is a cross-sectional view of the suture button of FIG. 10 shownin an assembled position relative to the bone plate of FIG. 5;

FIG. 15 is an exploded view of a bone fixation assembly constructed inaccordance to another example of the present teachings that incorporatesthe suture button of FIG. 11 and an alternate suture engaging member;

FIG. 16 is a cross-sectional view of the bone fixation assembly of FIG.15 and shown with an insertion tool passing the elongated member througha first hole in the clavicle and a second hole through the coracoidprocess during an implantation step;

FIG. 17 is a cross-sectional view of the bone fixation assembly shown inFIG. 16 and shown with the insertion tool removed and the suture tied inan implanted position; and

FIG. 18 is an exploded perspective view of a bone fixation assembly thatincorporates a suture configuration according to additional features.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

The following description of the various embodiments is merely exemplaryin nature and is in no way intended to limit the teachings, theirapplication or uses. While the following description is directed towardan apparatus and method for fixing a right clavicle relative to acoracoid process of a scapula and other surrounding anatomy of apatient, it would be appreciated that the same may be applied tofixation of a left clavicle. In this regard, the apparatus disclosedherein may be used in other implants including those that incorporate abone plate. For example, the apparatus disclosed herein may beincorporated in a periprosthetic situation where using a bone screw maybe insufficient or unfavorable such as when a far cortex may notadequately support the threads of the bone screw

With initial reference to FIGS. 1-3, a bone fixation assemblyconstructed in accordance with one example of the present teachings isshown and generally identified at reference numeral 10. The bonefixation assembly 10 is shown in an implanted position in FIGS. 1 and 3.Briefly, a patient's anatomy can include a clavicle 12 and a scapula 14having a coracoid process 16 and acromion 18. The clavicle 12 andacromion 18 can cooperate to form an articulating portion such as theacromioclavicular joint 20. Various ligaments can connect the clavicle12 with portions of the scapula 14 such as coracoclavicular ligaments 22(FIG. 2) that are connected between the clavicle 12 and the coracoidprocess 16. The clavicle 12 is illustrated having a fracture 26.Additionally, or alternatively, the coracoclavicular ligaments 22 can betorn. Such conditions can unfavorably cause the clavicle 12 to movegenerally superiorly and posteriorly relative to the coracoid process16. As will become appreciated from the following description, the bonefixation assembly 10 according to the present teachings, once implanted,can generally fix the clavicle 12 back to a desired position such thatthe unfavorable superior/posterior deflection of the clavicle can bereduced as well as re-approximate fractured clavicle 12 for healing.

With continued reference to FIGS. 1-3 and additional reference to FIGS.4 and 5, the bone fixation assembly 10 will be further described. Thebone fixation assembly 10 can generally include a bone plate 30, asuture button 32, and a suture assembly 34 including a suture 36 and asuture engaging member 38. The bone plate 30 can generally include anelongated plate body 42 having a sloped circumferential surface 44. Theelongated plate body 42 can further include an outer surface 46 and anopposite bone engaging surface 48 (FIG. 4). A plurality of threadedapertures 50 can be formed through the bone plate 30 from the outersurface 46 to the bone engaging surface 48. A threaded aperture 52 canbe located generally centrally on the bone plate 30. The threadedaperture 52 can be formed similar to the threaded apertures 50. In thisregard, the threaded aperture 52 includes threads 54 formed thereon. Itwill be appreciated that the shape and configuration of the bone plate30 is merely exemplary and that other bone plates may be used within thescope of the present teachings. Bone screws 56 may be threaded into thethreaded apertures 50 as needed to engage bone and/or tissue beyond thebone engaging surface 48 of the bone plate 30. In some examples, thebone plate 30 may additionally or alternatively incorporate non-threadedholes and/or slots that can each cooperatively receive a suture button32 (or other suture buttons having different configurations).

Referencing now FIG. 6, a bone plate 30′ constructed in accordance toadditional features of the present teachings is shown. The bone plate30′ can include similar features as the bone plate 30 described above.In this regard, the bone plate 30′ can include an elongated plate body42′ having threaded apertures 50′. A threaded aperture 52′ locatedgenerally in the center of the bone plate 30′ can collectively definemultiple overlapping threaded apertures. In this regard, the threadedaperture 52′ can provide the surgeon with additional versatility forlocating a suture button 32 during implantation.

With particular reference now to FIGS. 7-9, the suture button 32 will bedescribed in greater detail. The suture button 32 generally comprises abody 60 that includes a first end surface 62, a second end surface 64,and a circumferential outer surface 66. A first pair of passages 70 areformed through the body 60 from the first end surface 62 to the secondend surface 64. A second pair of apertures 74 are formed through thebody 60 from the first end surface 62 to the second end surface 64. Thefirst pair of passages 70 are generally defined by a first pair ofradial sidewalls 78 and a corresponding pair of chamfer surfaces 80 thatconnect the radial sidewall 78 with the first end surface 62. Similarly,the second pair of apertures 74 can be generally defined by acorresponding pair of radial sidewalls 82 and a pair of chamfer surfaces84 that generally connect the radial sidewalls 82 with the first endsurface 62. The body 60 can generally define a pair of radial openings88 that are formed through the circumferential outer surface 66 andconnect with the second pair of apertures 74. As will becomeappreciated, the first and second pair of passages 70 and 74 can beconfigured to accept the suture 36 therethrough when securing the sutureassembly 34 to the suture button 32. The radial openings 88 can offer asurgeon radial access for the suture 36 to the second pair of apertures74.

A central passage 90 is formed through the body from the first endsurface 62 to the second end surface 64. The central passage 90 cangenerally be defined by a central radial sidewall 92 and a correspondingcentral chamfer surface 94. A plurality of radial protrusions orretaining ribs 98 extend from the circumferential outer surface 66. Inthe example shown, six pair of discontinuous and equally spacedretaining ribs 98 are positioned around the circumferential outersurface 66. As will be described herein, the retaining ribs 98 can beconfigured to positively locate and engage the threads 54 formed on thebone plate 30 in an assembled position. It will be appreciated that inother configurations the retaining ribs 98 can engage other featuresincorporated on the bone plate 30 such as a groove or chamfer. It otherexamples, the suture button 32 may be configured without the retainingribs 98.

Returning now to FIG. 2, the suture assembly 34 will now be describedaccording to one example. The suture engaging member 38 illustrated inFIG. 2 can generally define an elongated body 104 having a first eyelet106 and a second eyelet 108. In general, the suture engaging member 38can have a profile that can be advanced through a first bone hole 110prepared in the clavicle 12 and a second bone hole 112 prepared in thecoracoid process 16. In the particular example shown, the sutureengaging member 38 is in the form of a ToggleLoc™) offered by BiometSports Medicine, LLC of Warsaw, Ind. Additional features and descriptionof the ToggleLoc™ may be found in commonly owned U.S. Pat. No.7,500,983, which is expressly incorporated herein by reference. Otherretaining members may be additionally or alternatively used to locatethe suture 36 relative to the coracoid process 16.

With particular reference now to FIG. 4, one example of implanting thebone fixation assembly 10 according to the present teachings will bedescribed. Initially, the preferred orientation and location of the boneplate 30 will be assessed by the surgeon. Similarly, a properly sizedcomponent of the bone fixation assembly 10 for the particular patientand injury to be treated can be selected.

The first bone hole 110 can then be prepared through the clavicle 12.The second bone hole 112 can then be prepared through the coracoidprocess 16. The bone plate 30 can then the positioned against theclavicle 12 such that the bone engaging surface 48 engages the clavicle12. The suture engaging member can then be advanced through the firstand second bone holes 110 and 112 and rotated generally into theposition illustrated in FIG. 4 where the elongated body 104 cangenerally engage an outer surface of the coracoid process 16 and fix afirst portion of suture 36. A second portion of the suture 36 can thenbe located through any combination of the first and second pairs ofpassages 70 and 74 of the suture button 32.

The suture button 32 can be advanced at least partially into thethreaded aperture 52 until the retaining ribs 98 engage the threads 54or other feature on the bone plate 30. It is contemplated that theretaining ribs 98 can achieve a snap fit or otherwise attain a fixedrelationship relative to the bone plate 30. The suture 36 can then betied as illustrated at reference number 120. It is contemplated that thesequence of steps may be altered as needed. For example, a surgeon mayadvance the suture button 32 into the threaded aperture 52 concurrentlywhile tying the knot 120. The arrangement of the bone fixation assembly10 of the present teachings provides a surgeon the ability to captureand fix a length of clavicle 12 that may have a fracture 26 whileconcurrently offering a tension and retaining force between the clavicle12 and the coracoid process 16 with one fixation assembly. Such anarrangement can also be particularly advantageous when addressing aclavicle 12 that has torn or damaged coracoclavicular ligaments 22. Itis contemplated that the bone fixation assembly 10 may be offered in apre-packaged kit.

With reference now to FIGS. 10-12, a suture button 132 constructed inaccordance to additional features of the present teachings will bedescribed. The suture button 132 can include similar features asdiscussed above with respect to the suture button 32. The suture button132 can have a body 133 that includes an upper portion 134 and a lowerportion 136 (see FIG. 12). The upper portion 134 can have an upperdiameter 138 while the lower portion 136 can have a lower diameter 140.The upper diameter 138 can be greater than the lower diameter 140 suchthat the upper portion 134 can sit proud relative to an outer surface 46of the bone plate (see FIG. 14). The body 133 can generally include afirst end surface 142 and a second end surface 144. Radial protrusionsor retaining ribs 146 can be formed around a circumferential surface 148of the lower portion 136.

Two pairs of passages 150 can be formed through the body 133 from thefirst end surface 142 to the second end surface 144. A central passage154 can be formed through the body 133 from the first end surface 142 tothe second end surface 144. Each passage 150 can have an axis 160 thatdefines an angle 162 relative to an axis 164 of the central passage 154.The passages 150 are defined by a pair of radial sidewalls 170 (FIG. 12)and a corresponding pair of chamfer surfaces 172 (FIG. 11) that connectthe radial sidewall 152 with the first end surface 142. The passages 150generally taper inwardly from the first end surface 142 to the secondend surface 144. Such a configuration can offer a surgeon more space tomanipulate suture extending from the passages 150 as well as maneuver arod 180 of a insertion tool 182 (as is described herein with respect toFIGS. 15-17).

Turning now to FIGS. 15-17, a bone fixation assembly 210 constructed inaccordance to additional features of the present teachings will bedescribed. The bone fixation assembly 210 generally includes the boneplate 30, the suture button 132, and a suture assembly 212 that includesa suture engaging member 214 and a suture 216. It is appreciated thatwhile the bone fixation assembly 210 is described herein as beingassociated with the suture button 132, the suture button 32 can be alsoused. Similarly, while the suture engaging member 214 will be describedas associated with the embodiment of FIGS. 15-17, the suture engagingmember 38 can alternatively be used. The suture engaging member 214 cangenerally include an elongated member 217 having a flexible tube 218that defines a passage 220 therethrough. In one example, the sutureengaging member 214 can include a JuggerKnot™ Soft Anchor offered byBiomet Sports Medicine, LLC of Warsaw, Ind.

The insertion tool 182 can generally include a handle 222 that isconnected to the rod 180. During use, once a first bone hole 110 hasbeen prepared in the clavicle 12 and the second bone hole 112 has beenprepared in the coracoid process 16, a distal end 224 of the rod 180 canbe used to pass the suture engaging member 214 with a portion of suture216 through the first bone hole 110 of the clavicle 12 and the secondbone hole 112 of the coracoid process 16 until the suture engagingmember 214 extends out of the second bone hole 112 of the coracoidprocess 16 (FIG. 16). Next, the insertion tool 182 can be withdrawn fromthe coracoid process 16 and the clavicle 12. A second portion of thesuture 216 can be located as desired through respective passages 150 inthe suture button 132. The suture 216 then can be pulled causing theflexible tube 218 of the suture engaging member 214 to generally expandto a position shown in FIG. 17 and inhibit the suture 216 from beingwithdrawn through the second bone hole 112 of the coracoid process 16.The suture 216 can then be tied at reference numeral 250 as shown inFIG. 17. The suture button 132 can then be advanced at least partiallyinto the threaded aperture 52 causing the retaining ribs 146 topositively lock with the threads 54 of the threaded aperture 52. Again,it will be appreciated that the sequence of steps are exemplary and maybe altered as needed. It will be appreciated that the desired amount oftension can be applied to the suture 216 causing the clavicle 12 to bemoved to a desired orientation.

Turning now to FIG. 18, a bone fixation assembly 310 constructed inaccordance to additional features of the present teachings will bedescribed. The bone fixation assembly 310 generally includes the boneplate 30, the suture button 132, and a suture assembly 312. The sutureassembly 312 can include a ZipLoop™ suture configuration offered byBiomet Sports Medicine, LLC of Warsaw, Ind. The ZipLoop™ may be threadedfor use with the passages 150 formed through the body 133 of the suturebutton 132. The suture assembly 312 may cooperate with a suture engagingmember such as the suture engaging member 38 shown in FIG. 4 (FIG. 4)described above. Additional description of the ZipLoop™ and itsoperation may be found in commonly owned U.S. Pat. No. 7,658,751, issuedon Feb. 9, 2010; U.S. Pat. No. 7,601,165, issued on Oct. 13, 2009; andpending U.S. application Ser. No. 12/719,337, filed on Mar. 18, 2010,which are all expressly incorporated herein by reference.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure.

1. (canceled)
 2. A method of implanting a bone fixation assembly, themethod comprising: positioning a portion of a suture through an eyeletin a suture engaging member to form first and second suture strandsextending from opposite sides of the eyelet, the suture engaging memberbeing elongated along a longitudinal direction; advancing the sutureengaging member in a longitudinal orientation through a bone plateaperture in a bone plate, through a clavicle hole in a clavicle, andthrough a coracoid process hole in a coracoid process, so that the firstand second suture strands extend from the eyelet sequentially throughthe coracoid process hole, the clavicle hole, and the bone plateaperture; advancing a suture button over the first and second suturestrands into the bone plate aperture; securing the suture button to thebone plate by engaging retaining ribs formed on a circumferentialsurface of the suture button with one or more threads formed in the boneplate at the bone plate aperture; pulling on the first and second suturestrands to: pivot the suture engaging member away from the longitudinalorientation so that the suture engaging member has an outer profileunsuitable for entering the coracoid process hole, and produce tensionbetween the suture engaging member and the bone plate; and tying thefirst and second suture strands together to maintain the tension.
 3. Themethod of claim 2, wherein the first and second suture strands extendthrough respective first and second longitudinal passages in the suturebutton.
 4. The method of claim 3, wherein the first and second passagesare positioned on opposite sides of a longitudinal axis of the suturebutton.
 5. The method of claim 4, wherein the first and second passagesare radially accessible through a lateral edge of the suture button. 6.The method of claim 4, wherein the first and second passages areradially inaccessible through a lateral edge of the suture button. 7.The method of claim 2, wherein: the first and second suture strandsextend through a single longitudinal passage in the suture button; andthe first and second suture strands are tied together in a knot that istoo large to fit in the single longitudinal passage.
 8. The method ofclaim 2, wherein the retaining ribs are discontinuous around thecircumference of the suture button.
 9. The method of claim 2, whereinthe retaining ribs are arranged in groups around the circumference ofthe suture button, the ribs in each group being longitudinally offsetfrom one another.
 10. The method of claim 2, further comprisingpositioning the bone plate proximate the clavicle.
 11. The method ofclaim 2, further comprising: preparing the clavicle hole through theclavicle; and preparing the coracoid process hole through the coracoidprocess.
 12. A method of implanting a bone fixation assembly, the methodcomprising: locating a portion of a suture through a bone plate aperturein a bone plate, through a clavicle hole in a clavicle, and through acoracoid process hole in a coracoid process, until a retaining memberslidably disposed on the portion of the suture locates against an outersurface of the coracoid process; passing a second portion of the suturethrough a suture button aperture defined in a suture button; positivelylocating the suture button into the bone plate aperture includingengaging retaining ribs formed on a circumferential surface of thesuture button with one or more threads formed in the bone plate at thebone plate aperture; drawing the second portion of the suture away fromthe outer surface of the coracoid process causing tension between theretaining member and the bone plate; and securing the second portion ofthe suture at a position that maintains the tension.
 13. The method ofclaim 12, wherein drawing the second portion of the suture away from theouter surface of the coracoid process comprises: manipulating theretaining member from a first position that has an outer profilegenerally suitable to pass through the clavicle hole and the coracoidprocess hole to a second position that has an outer profile generallyunsuitable to pass through the coracoid process hole.
 14. The method ofclaim 12, wherein drawing the second portion of the suture away from theouter surface of the coracoid process comprises: manipulating theretaining member from a first position that has an outer profilegenerally suitable to pass through the clavicle hole and the coracoidprocess hole to a second position that has an outer profile generallyunsuitable to pass through the clavicle hole and the coracoid processhole.
 15. The method of claim 12, further comprising: positioning thebone plate proximate the clavicle; preparing the clavicle hole throughthe clavicle; and preparing the coracoid process hole through thecoracoid process.
 16. The method of claim 12, wherein the retaining ribsare discontinuous around the circumference of the suture button.
 17. Themethod of claim 12, wherein the retaining ribs are arranged in groupsaround the circumference of the suture button, the ribs in each groupbeing longitudinally offset from one another.
 18. A method of implantinga bone fixation assembly,the method comprising: preparing a claviclehole through a clavicle; preparing a coracoid process hole through acoracoid process; positioning a bone plate having an aperture proximatethe clavicle; locating a portion of a suture through the aperture, theclavicle hole, and the coracoid process hole, until a retaining memberslidably disposed on the portion of the suture locates against an outersurface of the coracoid process; passing a second portion of the suturethrough an aperture defined in a suture button; positively locating thesuture button into the bone plate aperture including engaging retainingribs formed on a circumferential surface of the suture button with oneor more threads formed in the bone plate at the aperture; drawing thesecond portion of the suture away from the outer surface of the coracoidprocess causing tension between the retaining member and the bone plate;and securing the second portion of the suture at a position thatmaintains the tension.
 19. The method of claim 18, wherein drawing thesecond portion of the suture away from the outer surface of the coracoidprocess comprises: manipulating the retaining member from a firstposition that has an outer profile generally suitable to pass throughthe clavicle hole and the coracoid process hole to a second positionthat has an outer profile generally unsuitable to pass through theclavicle hole and the coracoid process hole.
 20. The method of claim 18,wherein the retaining ribs are discontinuous around the circumference ofthe suture button.
 21. The method of claim 18, wherein the retainingribs are arranged in groups around the circumference of the suturebutton, the ribs in each group being longitudinally offset from oneanother.